The Journal Club

In the midst of the information revolution, peer-reviewed publications remain key to the vetting and dissemination of new biomedical knowledge. And many College of Medicine faculty members assist in that task.

A cartoon from a 1995 New Yorker magazine depicts a physician sitting at his desk in a traditional, diploma-decorated office, speaking to a patient. The caption reads: “Mr. Wilkins, I believe your condition is going to get us both into the Journal of the American Medical Association.” Even after more than 15 years, the cartoon’s message isn’t dated; physicians and scientists continue to seek high-impact journal publication to disseminate new knowledge. In the process, they further their careers and, more important, they further the incremental improvement of understanding diseases and offering more successful treatments to patients worldwide. Unlike mainstream commercial publishing, which is heavily concentrated in a few major cities, scientific journals are headquartered throughout the country, and draw their contributions from any of the nation’s 135 medical schools and many independent clinics and institutes. At the UVM College of Medicine, faculty members from across a range of departments support the editorial process that keeps the peer-reviewed journal the dominant mechanism for the vetting and sharing of new medical information.

The scientific journal has been around since the very beginnings of the magazine as a medium. Prior to the mid-seventeenth century, physicians shared information through informal networks of correspondence. With the simultaneous appearance in the mid-1600s of both scientific societies and the newspaper, the stage was set for the appearance of the first steps in formal scientific publication, with the French Le Journal des Sçavans, and the English Philosophical Transaction of the Royal Society of London both premiering in 1665. More than a century later, in 1797, The Medical Repository became the first scientific journal published in the United States. It was printed in New York City, as its title page stated, for “the Faculty of Physic of Columbia College.” Throughout the nineteenth century the numbers of medical journals grew at a rapid rate, as did the concept of having submissions reviewed by peers in specific fields before publication. Today, between 4,500 and 5,500 biomedical journals are published worldwide, and a count by the journal Science Watch showed that nearly three million scientific papers were published by American investigators in the ten years between 1996 and 2006, of which a hefty portion were biomedical in theme.

With the rise of Internet publishing, smart phone and tablet applications, blogs, and online social media, information sharing among scientists has become more fluid and accessible. However, the hard copy, peer-reviewed journal is still the “gold standard” of publishing, even as new technology has changed the way many have accessed its information. The task of editing a journal — and determining article acceptances — remains a rewarding experience. Several College of Medicine faculty members have become intimately familiar with the challenges and rewards of serving as an editor-in-chief — including Lewis First, M.D., at Pediatrics, Jeffrey Klein, M.D., at RadioGraphics, Naomi Fukagawa, M.D., Ph.D., at Nutrition Reviews, and Burton Sobel, M.D., at Coronary Artery Disease; in addition, several faculty serve in the important role of associate editor, including Jason Bates, Ph.D., at the Journal of Applied Physiology, Mary Cushman, M.D.’89 at the Journal of Thrombosis and Haemostasis, James Hudziak, M.D., at the Journal of the American Academy of Child and Adolescent Psychiatry, and David Schneider, M.D., at Coronary Artery Disease. Here, we profile just a sampling of these editors.

Lewis First, M.D. Editor, Pediatrics

At UVM, no one knows the burden of shouldering an editorial role on top of research, teaching, and patient care responsibilities better than Jerold Lucey M.D., professor emeritus of pediatrics. For 34 years, Lucey sat at the editorial helm of Pediatrics, the monthly journal of the American Academy of Pediatrics. His successor, Lewis First, M.D., professor and chair of pediatrics, became editor-in-chief in January 2009, adding the challenges of keeping a major journal up-to-date and constantly adapting to reflect changes in the field, while maintaining his duties as department chair, chief of pediatrics and physician leader at Vermont Children’s Hospital at Fletcher Allen Health Care, as well as his active service within the community.

Pediatrics operates out of several offices — one at UVM, where First, Associate Editors Jeffrey Horbar, M.D., and William Raszka, M.D., and Editorial Associates Martha Andreas and Deana Stoppler work; another in Houston, Texas, for Deputy Editor Virginia Moyer, M.D., Associate Editor Gordon Schutze, M.D., and Assistant Editor Claudia Kozinetz, M.D.; and at the AAP headquarters in Elk Grove, Illinois, occupied by the journal’s senior managing editor, managing editor, and an editorial associate.

“We receive more than 4,000 manuscripts from the U.S. and around the world each year,” says First, who credits Lucey with elevating Pediatrics to its current status as the most highly referenced pediatrics journal in the world, producing multiple translated editions and developing the journal’s online edition. “Jerry was a master at editing, article selection, judgment, and recognizing what readers need,” says First. “He is a great mentor for me.”

First describes Pediatrics as a team effort. He and Deputy Editor Moyer speak almost daily and each week, they have a “triage” call to determine which of the 100 newly reviewed articles on hand will be accepted. Horbar oversees the dozens of letters to the editor received each month. Raszka covers the office’s day-to-day operations when First is out, and has gained notoriety among Pediatrics readers as “the filler king” — he writes short one- to two-paragraph current news-related feature items that fill space at the end of articles in the hard-copy edition of the journal.

First believes the complexity of editorial responsibility nowadays precludes him from being sole decision maker. He holds a monthly conference call with his ten executive board members regarding policies, controversial papers, and the governance of the journal. And twice a year, he holds meetings with his 40-member editorial board, which is made up of pediatricians from all over the U.S. Two to three times each year, First convenes a meeting of other pediatric journal editors, who represent such publications as Clinical Pediatrics, Journal of Pediatrics, Pediatrics Research and Adolescent Medicine. Collectively, these leaders share and brainstorm about such issues as conflict of interest policies, pre-registration of clinical trials, and how to consider industrial pharmaceutical studies.

Since becoming editor-in-chief, First and his team have also revamped the look of the journal and increased the use of online technology and social media to make the journal more user-friendly. They also created a dynamic website with a blog, authored by First (and aptly titled “First Read”) that highlights new articles. In 2010, Pediatrics received two awards from Association Media & Publishing — a gold award in the journals category for “most improved,” and a silver award for design excellence.

Another recent accomplishment is the reduction of time from acceptance of a paper to its publication from almost a year to two to three months. Letters to the Editor — or e-letters — are posted online, usually within a day.

With an aim to be as accessible as possible, First devotes the second half of his work-day to addressing authors’ concerns and complaints, walking contributors through revisions. “It’s exciting to call people all over the world and help them write better manuscripts,” says First.

A combination of a tight page budget and sharp uptick in the number of submitted manuscripts means Pediatrics cannot publish all the submissions worthy of publication. “That’s a good indication that there is so much good work being done in our field,” he says.

Jeffrey Klein, M.D. Editor, RadioGraphics

A. Bradley Soule and John P. Tampas Green and Gold Professor of Radiology Jeffrey Klein, M.D., recently embarked on a six-month transition period in preparation for assuming the editorship of RadioGraphics, the bi-monthly journal of the Radiological Society of North America (RSNA). Klein will be the journal’s third editor when, in January 2012, he succeeds University of Maryland radiologist William Olmsted, M.D., who served as the journal’s editor for 21 years.

RadioGraphics is unique in that it is almost exclusively educational. The journal’s articles are selected from accepted educational exhibits at RSNA’s Annual Meeting, which takes place in Chicago in late November each year. The editorial team identifies exhibits with high-quality content and images that will translate well into a journal article, then invites authors to convert their exhibits into a journal article format for peer review for inclusion in one of the six issues for that year. A seventh issue of the journal, published in October, focuses on a specific topic.

Klein, who previously served as the editor of the Journal of Thoracic Imaging, is a practicing radiologist, educator, and researcher. “It’s difficult to leave clinical practice at any point,” he says. Klein estimates he will dedicate about 70 percent of his time to editing, leaving about a third to care for patients and interpret studies. Two associate editors share the workload, and are responsible for quality improvement and informatics, editing regular articles in each issue. In addition, the journal has a managing editor at the RSNA headquarters in Oak Brook, Ill., an editorial associate in the Vermont office, and a 25-member editorial board support the effort.

On rare occasions, says Klein, RadioGraphics will publish an article not solicited from an Annual Meeting exhibit, if that topic isn’t addressed by an exhibit. “We try to match topics with what readers want and need,” says Klein, adding that members are solicited for a top ten list of what’s “hot” to determine topics.

While currently in the process of expanding from print to electronic — only two articles per issue are available online — Klein says RadioGraphics is widely considered the best educational journal in radiology. “It’s a real challenge to decide how the journal maintains its identity and evolves into its electronic version, and I have to shepherd it into that realm successfully,” Klein says.

Christopher Francklyn, Ph.D. JBC Editorial Board

Some journals, like Pediatrics, publish monthly; others are bi-monthly, like RadioGraphics, but many are published weekly. Professor of Biochemistry Christopher Francklyn, Ph.D., who is nearing the end of a five-year term on the editorial board of The Journal of Biological Chemistry (JBC), a weekly publication focused on research that seeks to gain an understanding of the molecular and cellular basis of biological processes.

Francklyn possesses a distinct opinion about the gravity of editorial responsibility, influenced by a meeting early in his career with the late Sir John Maddox, former editor of the journal Nature. “You are a chief quality control officer — deciding what does and doesn’t go in the journal — responsible for standards of science and resolving conflicts,” he emphasizes, adding that “editors have to have the experienced-based judgment to know a paper’s good enough and the balance to not push for too much.”

He puts this philosophy into practice as a reviewer, a duty that entails evaluating about 30 papers per year, with an average two to three papers “in the queue” at all times. Each article has two reviewers and a third is added if the first two don’t reach agreement. Editors can operate at their discretion, such as recommending a third reviewer to get an opinion from a specific expert to solidify an opinion.

Francklyn subscribes to the “golden rule” of peer review: he reviews just as he wishes to be reviewed. On his fit-for-publication criteria checklist is evidence of interesting and important work, especially novel discoveries, and sufficient data to prove the study’s case. Determining what would make it a better paper is also part of the equation for Francklyn. “If someone discovers something important in the field, I want to get it out there and get people excited,” he says.

His willingness to help promising scientists get their work published has resulted in another editorial role as a regular contributor and editorial board member of Principal Investigator Advisor (PIA) and NIH & NSF Funding Advisor. This year-old opportunity landed in Francklyn’s lap after he posted a comment in response to a column about reviewing that appeared in The Scientist, a New York-based magazine that covers the latest developments in the life sciences. Leslie Norins, M.D., Ph.D., publisher of PIA, read the online comment and called him to be a contributor. “I figured I would pass it along, sharing more broadly those things I’d share with a junior colleague down the hall,” Francklyn says.

“When you are judged as a scientist, where you publish makes a difference,” he says. He considers issues like how to measure impact and standards that determine innovation some of the most critical discussions in the journal field. “You are a ‘custodian’ of your field, so it’s subjective judgment; you bring your own personal ethics to the table,” he admits. In the academic world, says Francklyn, “people put lots of time into reviewing that’s never compensated in the strictest sense. But all people involved in the process of producing a journal know that the work pays dividends for those who contribute today, and those who glean knowledge far into the future.”